Anal Fissures

Easily and permanently solved by surgery

Premise

Distinction should be made between hemorrhoids and anal fissures. Hemorrhoids are varicose veins inside the rectum near the anus, are different from fissures, and are dealt with in another section of this site. This said, we can start explaining how a fissure is formed.

How fissures are formed

During defecation the anus dilates to pass stool, and usually the normal dilation of the anus is sufficient to perform this physiological function effortlessly and without any skin break. But if for some reason the anus dilates too much then it could happen that the skin at the anus tears and breaks.

The excessive dilation of the anus is obviously due to feces big and hard, and in general constipated persons are subject to this type of drawback.

The break for stripping of the skin of the anus looks like a small notch, from which a slight bleeding can be seen both in the wc and on the toilet paper. Many people say that once in a while (a few times a year, on average) are subject to this type of bleeding.

Should be noted that the blood that comes out of these small tears in the skin of the anus is bright red (fresh blood), but if you were to observe bleeding dark red it would be attributed to much more serious problems of internal bleeding, which your doctor is to be informed immediately.

The occasional bleeding anus is not a fact problematic: the small laceration heals itself in a few days as any other excoriation of the skin in any other part of the body.

Nonetheless, you don't have to worry about the passage of stool into contact with a fresh skin laceration: the bacteria contained in the feces are all well known by the human body. The bacteria are combated by the immune system, and cannot cause infections of concern (however a minimum of cleaning does not hurt, especially in these circumstances...).

It is noted that usually, for mechanical issues and conformation of the anus, in case of repeated lacerations (even at a distance of months and years) the breaking point of the skin is always the same. It may happen to people subject to this phenomenon, that one fine day the tear does not heal anymore.

The tear that does not heal is called fissure, and it is a disease much more common than you might think because people who suffer from it are ashamed to talk about it to the doctor, and there are cases of people who have dragged for years with the problem of a fissure in the anus.

Suffering

The anal fissure is a minor disease, in fact it is not a cause of death, but is very painful, so painful as to cause a range of additional diseases including the fear of defecate, with the aggravations that come with it.

The patient who is suffering from anal fissure is unable to sit, and cannot rest even while standing or lying in bed. The night is hard to fall asleep, the next morning you wake up more tired than when you went to bed, work and daily activities are carried out with difficulty.

Why the anal fissure is formed

Let's see now, from the pathophysiological standpoint, how a fissure is made and why it causes such a pain. Start considering that the anus is surrounded by the sphincter, which is a ring-shaped muscle that surrounds the anus. The contraction of the sphincter prevents the output of the fecal material from the rectum, while its relaxation allows regular defecation.

The sphincter is composed of two parts: the voluntary and the involuntary sphincters. The contraction and relaxation of the involontary sphinter are managed by the central nervous system of the human being. The voluntary sphincter, however, is controlled by our will, and we can contract it or relax it at will.

Back to the bleeding laceration of the skin of the anus, to let the wound heal it is necessary the sphincter to be not excessively contracted, indeed must be slightly relaxed. In fact, excessive contraction prevents proper blood circulation around the anus.

For unknown reason it happens that the involuntary sphincter remains hyper-contracted for long periods of time, and this in itself would not be a problem if the skin of the anus were intact. But if the skin is broken, it happens that the scarring and healing do not happen again (since poor blood circulation causes lack of oxigen, which is needed to heal) and the laceration is transformed into the permanent so-called "anal fissure".

Ultimately the fissure is a small "nick" on the skin of the anus, caused by excessive strain, which does not heal anymore due to a long and persistent involuntary sphincter contraction. In the long run the fissure becomes, as said, very painful.

Healing the fissure

To allow the healing of the fissure is necessary to relax somewhat the involuntary sphincter, so as to give time to the laceration to heal spontaneously. To achieve this there are several methods:

mechanical dilators

application of nitroglycerin ointment

Botox injections

surgery

Mechanical dilators

The mechanical dilators are shaped tubes made of hard plastic to be pushed into the anus (with a special lubricating cream) to dilate the anus up to a diameter ranging from 2 to 4 centimeters, causing a forced relaxation of the involuntary sphincter.

The application of the dilators, increasing the diameter, must take place at least twice a day for a period of time ranging from 5 minutes to a maximum of 1 hour. During the application must stand still (to pass the time you can watch TV).

The medical literature on the application of dilators prescribes the cure for a minimum period of one month, and this results in a kind of ordeal for the patient because the use of dilators is uncomfortable (and painful, especially in the early days).

If we consider that this healing technique is practically ineffective it is concluded that it is a pure waste of time. The doctors advise mechanical dilation to those who are afraid to undergo the surgery and Botox injections. In these cases, however, treatment with dilators anyhow causes an effect: to convince the patient to undergo surgery.

Application of ointment

The application of ointment is an effective temporary remedy. It is 2% nitroglycerin ointment (glycerine nitrate) that you get (on prescription) only in pharmacies running galenic preparations. As a neutral vehicle of the active ingredient it is preferred a lubricating paste and not a gel. The ointment tube, ready for use, can also be found in U.S and Canada.

The ointment should be applied morning and evening directly on the anus, using your finger, and ensuring that the preparation also comes in slightly on the inside of the anus.

If the ointment is applied correctly (i.e. it is applied exactly on the affected part) the relief is almost immediate. Indeed nitrate glycerin has the property to make the involuntary spinter sleep for a fair number of hours. The effect is so effective that normally a few weeks of treatment leads to healing, because it is missing the root cause of the fissure, which is the continuous strong contraction of the involuntary sphincter.

The serum botulinus

Alternative to the ointment (which however requires the patience of a double daily application) is the injection of serum botulinum. This serum is also used in cosmetic surgery to relax wrinkles. The botulinum toxin, as is known, is the bacterium most toxic in the world, so toxic that the ingestion of a few milligrams causes the death of a person.

The serum botulinus, which is very expensive, it is a diluted preparation of the poisonous bacterium. This preparation is for injection, and has the effect of relaxing any muscle it comes in contact with.

Some injections of serum botulinus in the perianal area relaxes the involuntary sphincter for several months, and lead to healing for the same reason that we have explained with the application of nitroglycerin ointment.

The problem with this method is that the injections are very painful, in the nearby of an area already injured because of the fissure, and therefore patients who wish to undergo this cure are not so many.

Relapses

The cream and the serum botulinus lead to healing, but do not prevent relapse, and relapse of the fissures are quite likely to happen.

The surgical operation

Therefore, the only true therapy for definitively resolving the anal fissure is the surgery performed by a specialist. A well-executed operation certainly prevents the relapse of the fissure, and we'll see why.

The surgery is not very demanding for the patient, so much so that it may even be performed on an outpatient basis, that come in the morning and go out in the evening, but usually it is advisable to make the patient stay a full day of hospitalization.

The surgery requires anesthesia, which can also be local, but we recommend a light general anesthesia. Ultimately the time of surgery is only 15 minutes, so you do not remain asleep for long.

The intervention, preceded by a purge to spill the intestinal beans, consists in the execution of the following:

mechanical expansion of the part to operate

small plastic tearing, reporting locally to a piece of skin taken elsewhere and secured with 3 or 4 points

In the aftermath of the operation the swab is removed, and the patient returns home. Defecation can occur immediately and regularly without any problem. The closure of the small wound occurs in 4 weeks, after which the points will dissolve or fall on their own.

The post-operative is not painful, and for some possible discomfort you can take 15 drops of Toradol on occasion. You can sit as early as the day after the operation, although it is better to lie or stand for a couple of days more. Or you can sit trying not to put pressure on the affected part.

Partial cutting involuntary sphincter, if done well, is a guarantee against the return of the fissure. An involuntary sphincter partially cut prevents those strong involuntary contractions that do not allow the healing of lacerations of the skin of the anus, and at the same time continues to exert its containment capacity within the limits of normality. On the other hand, for the purposes of continence, there is always the voluntary sphincter to avoid embarrassing situations.

The excessive cut of the involuntary sphincter or, worse, the unwanted cut of the voluntary sphincter, can make disabled a person. So it is necessary the operation being performed by an experienced surgeon.

The surgery of the anal fissure, as mentioned, prevents subsequent re-formation of the fissure, but even if perfectly executed, it does not prevent further subsequent breakage of the skin of the anus. So it is good to know that some occasional bleeding can always occur in the future. However, the recovery is assured.

In these cases, to accelerate healing of the usual tear (healing which, however, would occur spontaneously), it is useful to spread the anus with the tip of the finger using a small amount of a zinc paste, and in particular right on the same tear before defecating. This application is still a good practice to be carried out once in a while, because it lubricates and protects such a delicate part of the body.

As mentioned above, the human body is familiar with and knows how to defend itself from bacteria present in feces, so if they come into contact with the tear can not cause infection, but in all cases, regardless of the presence of cracks or fissures, and then to all the individuals in general, it is always advisable the utmost cleanliness of the perianal region. This is to keep in good health and avoid unexpected complications.

Conclusions

To conclude we should speak of the relationship between what you eat and the production of hard and bulky stools, which are the cause of the break in the skin of the anus, the rupture, which in turn can be transformed into a fissure.

The tips that we are about to give are as elementary as little respected by the majority of the population. First, you need to drink water often, at least 5 or 6 glasses a day, and eat fiber-rich foods, such as fruit.

But the prince remedy against the hard stool is not water, but rather eating salad every day, once a day, quite a generous plate of salad topped best as we like. Aside from the fact that the salad is rich in minerals, it contributes significantly to softening the stool and making it easier to evacuate.

Constipation and hard stools are typical, among other things, of people who do not much physical activity, such as people who make office life. These people are advised to always keep a bottle of water on their desk, from which to drink frequently, possibly at least a liter per day.

The suggestion of drinking water is valid, but it is much more important to have lunch eating fruit, or yogurt, or even better abundant salad (instead of the usual sandwich or pizza). This is the most advisable thing for people coming out of the house in the morning and returning home in the evening, and that inevitably are forced to make the main meal at night.

Finally, it is advisable to walk as much as possible, preferably at a steady pace. You should walk at least half an hour a day. Who goes to the office by bus should get off a couple of stops in advance, and complete the journey on foot; while those who go to the office by car should park at a distance of one kilometer, or do a few laps of the building before going to work.